Healthcare Provider Details

I. General information

NPI: 1356206809
Provider Name (Legal Business Name): HICKSVILLE RX INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 W VILLAGE GRN
HICKSVILLE NY
11801-3912
US

IV. Provider business mailing address

34 W VILLAGE GRN
HICKSVILLE NY
11801-3912
US

V. Phone/Fax

Practice location:
  • Phone: 516-513-1374
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ILYA NEKTALOV
Title or Position: OWNER
Credential:
Phone: 516-513-1374